Peter Freese and Nick Newhard particularly stressed the game's influence on Blood, with the latter's control acceleration described as a partial reverse engineering of the former. The underlying Build engine used in Blood was sector based because creator Ken Silverman learned of the technique from a June 1993 phone call with Carmack. The designers stated that they intended BloodBath to honour and surpass the heights of quality seen in Doom deathmatch.

id later released the source code to the engine on December 23, 1997, first under the restrictive Doom Source License and later under the free softwareGNU General Public License on October 3, 1999. This allowed for the creation of innumerable source ports, brining the game to various modern operating systems and adding in new features such as jumping, mouselook and more. The source code for most of the other games based on the engine followed over time. Similar campaigns for the release of the Blood source code unfortunately failed, but source code for the Build engine itself and separately fellow titles Duke Nukem 3D (1996) and Shadow Warrior (1997) did come out.

The Doom engine was then later used in the fan made Blood game entitled Blood TC first released in 2006, as a total conversion for Doom II. A Blood Resource Pack was also earlier compiled as a texture WAD file allowing for the Doom engine to use Blood textures. It was created by Daniel "Tormentor667" Gimmer, who used it in his popular "The City of the Damned" map. Later maps by other authors such as "Infuscomus" and "Miskatonic Trip" carried over from this.

ZDoom is a modified version of the Doom engine made to include Build and Quake engine like effects. The Blood TC project switched to ZDoom and started the ZBlood effort because ZDoom is a lot closer to the Build engine used in Blood in terms of features. ZBlood can be used by all ZDoom compatible Doom source ports, most notably the modern GZDoom. The undertaking has also spawned numerous forks over the years, most notably and recently ZBloody Hell. ZDoom itself is also able to be ran with the Blood executable, which puts the BloodBath announcer known as The Voice into Doom. ZDoom can also limitedly run Blood maps and art files using the same method, but a lot of the Build specific effects do not work.

Because of its large community and easy modding support, the engine and its modern derivatives have become popular for Blood projects that require modifications to the base gameplay or the expansive addition of new assets not properly possible with the original Blood executable. Examples include Caleb Versus Nazis, Blood: Dead on Arrival, and other projects listed below such as Ultra Crispy. This helps fill in a gap that was acknowledged by the Blood developers as one of the greatest drawbacks of their game.

The Blood Prequel was a project by Ermi to create an open world shooter game set before the events of the original Blood using the ZDoom engine. It mostly features Caleb meeting Ophelia in her burnt out homestead in 1871, earning the initial ire of the Cabal. Released unfinished on January 23, 2015. Some of its more notable features included a dialogue and currency system.

Horror 3D was a project started on March 15, 2015 by Trevor "0402" James, which aimed to recreate the look and feel of Blood in its original "Horror3D" incarnation. This mostly involved using assets and ideas from the Blood Alpha. The effort was declared discontinued on May 31, 2017.

"Let's set our minds back to 1871. We all know the sad fate of the undead cowboy known as Caleb, main character of the Blood series and his thirst for vengeance, as he was betrayed by the dark god known as Tchernobog. When he (Tchernobog) killed the Chosen, and among them, Caleb's beloved Ophelia, he knew Caleb would seek revenge more powerful than ever, many years later. But what if Tchernobog used his powers to banish Caleb once and for all from that dimension? Caleb awakes in the middle of a demonic invasion on earth. But not that world he used to know. Things look too different. It's up to you to find some answers. Or maybe, you could wake up on a Dark-fantasy themed scenario, or even, a dystopic cyberpunk themed world! The possibilities are on your hands."--Background story

Ultra Crispy is a ZDoom mod based on the premise of Tchernobog banishing Caleb to alternative dimensions, namely IWADs such as Doom II, Heretic, Hacx or Freedoom, as well as PWADs and other mods for those games. It features custom weapons and the prominent inclusion of Caleb, but aims at broad compatibility with Doom engine games. Maintained by GAA1992 and first announced on May 16, 2018.